License To Deliver: Legal Lines Debated By Idaho Midwives

BOISE - The young mother's labor was too fast for a change of heart about giving birth in her own bedroom.

Colleen Hollis prayed and breathed. So did friends and family gathered at the house.

She gave birth to her fourth child without painkillers, doctors or a hospital room full of baby-monitoring equipment.

"It was a very comfortable situation," said 28-year-old Hollis, of Boise, who gave birth June 3 after two hours of labor.

The percentage of Idaho's babies delivered at home by midwives who lack nursing credentials is five times higher than the national average.

The overall numbers are small but significant. Last year in Idaho, 294 - or 1.6 percent of 18,538 births - were attended by midwives who are not nurses. That compares with 13,179 - or 0.3 percent - of 3,899,589 babies born nationwide in 1995, the most recent year for which comparable statistics are available.

Lay, or direct-entry, midwives are popular and can cite studies showing home births are safe for young, healthy women with uncomplicated pregnancies. But the midwives work in a legal gray area, their profession unregulated by the state.

So far, they have largely been ignored by authorities.

License to practice

Some Boise-area midwives worry that could change with the case of Karen Erickson, a Boise midwife under investigation for practicing medicine without a license.

Erickson is accused, among other things, of failing to diagnose

pre-eclampsia, a potentially fatal complication of pregnancy, in one of her patients. She also is suspected of obtaining and administering prescription drugs without a license.

"In Idaho, it is not illegal to have a home birth, but it is illegal to have a safe home birth," said Erickson, who agreed to be interviewed only with her lawyer, John Meienhofer, present.

She thinks if Idaho were a state that licenses midwives, she would not be under investigation by the Boise Police Department.

In Washington state, licensed midwives, Erickson among them, are allowed to get and use certain medications, including oxygen; Pitocin - a drug used to stop hemorrhaging; and antibiotic eye drops for newborns.

In Idaho and other unregulated states, it is often illegal, or at least legally unclear, whether midwives can prescribe the very medications needed to help that ensure home births are safe. Many midwives in Idaho and other states do it anyway, getting what they need from licensed colleagues, doctors friendly to midwives and other sources.

"Midwives don't feel bad about what they do," said Susan Moray of Portland, a media representative from the Midwives Alliance of North America and who is in the process of getting licensed in Oregon.

"Most feel great about the work they do," she said. "To have to be underground about it is demeaning."

Licensing can help patients pick qualified practitioners and can protect midwives from charges they are horning in on doctors.

Health-insurance coverage is better in states that set minimum requirements for training and education. Blue Cross of Idaho, the state's largest insurer, covers some nurse midwifery, but not the home births commonly attended by other midwives.

In Boise, midwives are split on whether licensing is a good idea.

"As midwives, we have always tried to be self-regulating, and we've looked at licensing over the years, and we've seen it to be very expensive," said Paulene Robbins, 47, who has practiced in Boise for 12 years.

Robbins advertises in the telephone book and is certified through the North American Registry of Midwives. At least nine states use NARM exams as part of their licensing processes.

The only government-regulated midwives in Idaho are certified nurse midwives - nurses who undergo extra training in midwifery. Nine nurse midwives are licensed in Idaho. Boise has one, who delivers babies at St. Alphonsus Family Maternity Center.

"There will always be women who want to give birth at home," said Liz Britain, Boise's certified nurse midwife.

She doesn't do home births, but Britain advises women who want such a birth to find a midwife with good judgment, not one with a history of avoiding modern medicine.

Risks of at-home birth

It's not worth the gamble to give birth outside the hospital, says at least one Boise doctor.

"You have the expertise, you have the backup, if things go wrong, you have all the necessary equipment to take care of it, expeditiously," said Dr. Mary Fran Woods, a Boise obstetrician and gynecologist.

Even uncomplicated pregnancies can turn difficult fast, she said.

After giving birth to her first three children in a hospital, Hollis and her husband, Thom, 29, chose to have their fourth baby, Danielle Nicole, at home.

Instead of a doctor or a specially trained nurse delivering the baby, the Hollises' birth attendant was a midwife with a kit of basic supplies.

Sandra Simons, 30, of Boise, lacks health insurance and was interested in a safe, less expensive option to hospital birth. Midwifery can cost $1,000 to $2,400 nationwide for prenatal care and home delivery. More conventional doctor-hospital care can cost thousands more.

A bad experience with Simons' second child's birth at a Boise hospital in 1996 led her to consider a home birth. Among other problems, Simons had trouble summoning her nurse during labor. And the doctor who attended her in the hospital joked about wanting to deliver the baby in time to make the ballet that night.

Her first two children were born quickly, after short labors and without medication. So, Simons thought, why not give birth at home?

"My friends think I'm crazy, and they say, OK, `granola woman,' " Simons said.

Her due date: Sept. 1.

"It's not like we can't afford to go to the hospital, but I'm very frugal," she said.

"With the $3,000 to $4,000 we save," she told her husband, "you can take me on a cruise."